Spontaneous Versus Directed Pushing in Labour

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There are two approaches to pushing in the second stage of labour. Directed pushing involves taking a deep breath at the beginning of a contraction, holding it and bearing down throughout the contraction. Conversely, spontaneous pushing allows women to follow their own instincts.

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What is this article about?

Management of the second stage of labour can vary considerably. Even though research evidence seems to favour spontaneous pushing, directed pushing is still often used. Which method is best? As every midwife knows, slow and controlled birth of the baby is important to prevent perineal trauma. Lemos et al. (2017) note that there is still no consensus on an ideal strategy for pushing during the second stage, and as Edqvist et al. (2016) point out, there is still very little high-quality research comparing directed versus spontaneous pushing during the active second stage of labour.

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Meet the educator

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Anne Watkins
Anne is a freelance lecturer and medical writer at Mind Body Ink. She is a former midwife and nurse teacher with over 25 years’ experience working in the fields of healthcare, stress management and medical hypnosis. Her background includes working as a hospital midwife, Critical Care nurse, lecturer in Neonatal Intensive Care, and as a Clinical Nurse Specialist for a company making life support equipment. Anne has also studied many forms of complementary medicine and has extensive experience in the field of clinical hypnosis. She has a special interest in integrating complementary medicine into conventional healthcare settings and is currently an Associate Tutor, lecturing in Health Coaching and Medical Hypnosis at Exeter University in the UK. As a former Midwife, Anne has a natural passion for writing about fertility, pregnancy, birthing and baby care. Her recent publications include The Health Factor, Coach Yourself To Better Health and Positive Thinking For Kids. You can read more about her work at
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What do others think?

451 reviews by Ausmed Learners
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Sandra Plowman
23 Jul 2020
Excellent article reviewing second stage management, the risks and outcomes of different techniques. Also identified areas needing more research
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Anna Bagus
24 Jul 2020
Great article
Katrina schulze
17 Jul 2020
When a baby is born vaginally it is very exhausting for a mother to be made to push her baby out and often a cs if required. It is much more benificial for a mother to use her natural instincts during childbirth.
Lynee White
25 Jul 2020
I felt that it was a very worth while reading. it give a greater understanding of the way that women would like to push when they birth their babies.
Maxine Fraser
25 Aug 2020
A great resource, with references that I was able to access and read for confirmation and clarification.
Sarah Russell
24 Jul 2020
This article was informative and precise, I gained more knowledge in the area of women labouring and giving them more independence.
Wendy Thornton
18 Jul 2020
Excellent quick read for managing second stage labour.
Perrina Bozanich
16 Aug 2020
good information
Javer Jawahir
24 Jul 2020
This resource was concise, short and very informative.
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Deborah Rossi
24 Jul 2020
Short, sweet and relevant. It is good to be able to access quick education resources such as this.
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